Provider Demographics
NPI:1851769327
Name:KOSTOUROS, ALEKA (LSW)
Entity Type:Individual
Prefix:
First Name:ALEKA
Middle Name:
Last Name:KOSTOUROS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 S 10TH ST APT 3R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2700
Mailing Address - Country:US
Mailing Address - Phone:612-791-0358
Mailing Address - Fax:
Practice Address - Street 1:ROOSEVELT BLVD & ADAMS AVE
Practice Address - Street 2:NORTHEAST COMMUNITY CENTER FOR BEHAVIORAL HEALTH
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124
Practice Address - Country:US
Practice Address - Phone:215-831-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1315931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical